Oncology Emergencies Quiz
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Questions and Answers

What is a classic clinical manifestation of Superior Vena Cava Syndrome?

  • Lower extremity edema
  • Facial and arm swelling (correct)
  • Increased blood pressure in the legs
  • Severe chest pain

Which treatment option is considered first-line for acute onset of Superior Vena Cava Syndrome?

  • Surgery
  • Radiation therapy (correct)
  • Diuretics
  • Chemotherapy

Which of the following is NOT a common cause of Superior Vena Cava Syndrome?

  • Extrinsic mass
  • Mass invading vessel wall
  • Thrombus around a central venous catheter
  • Pulmonary embolism (correct)

What potential complication can result from untreated Superior Vena Cava Syndrome?

<p>Congestive heart failure (C)</p> Signup and view all the answers

Which treatment must be used with caution due to its potential to decrease venous return?

<p>Diuretics (A)</p> Signup and view all the answers

What is a crucial nursing action for monitoring a patient with Tumor Lysis Syndrome?

<p>Assessment of vital signs at least every 4 hours (D)</p> Signup and view all the answers

What symptom is NOT typically associated with Syndrome of Inappropriate Anti Diuretic Hormone (SIADH)?

<p>Dehydration and thirst (D)</p> Signup and view all the answers

Which treatment is recommended for correcting sodium-water imbalance in SIADH?

<p>Fluid restriction (B)</p> Signup and view all the answers

When monitoring a patient for Tumor Lysis Syndrome, which laboratory values should be checked frequently?

<p>Serum uric acid levels and creatinine (B)</p> Signup and view all the answers

What complication can arise from the excess secretion of ADH due to cancer cells?

<p>Electrolyte imbalance and hyponatremia (D)</p> Signup and view all the answers

What is the nadir in relation to chemotherapy?

<p>The point at which the lowest blood cell count is reached (B)</p> Signup and view all the answers

Which absolute neutrophil count (ANC) range indicates moderate risk for infection?

<p>1000-500 (D)</p> Signup and view all the answers

What is the primary nursing intervention to reduce the risk of infection in neutropenic patients?

<p>Implementing strict handwashing protocols (C)</p> Signup and view all the answers

Which of the following is a common cause of fever in oncology patients?

<p>Infection (D)</p> Signup and view all the answers

When calculating ANC, what formula is used?

<p>Segs + Bands x WBC count / 100 (A)</p> Signup and view all the answers

What is the normal platelet count range in a healthy individual?

<p>150,000 - 400,000 (A)</p> Signup and view all the answers

Which symptom might indicate severe neutropenia?

<p>Fever without other symptoms (B)</p> Signup and view all the answers

What should patients with neutropenia avoid to decrease infection risk?

<p>Person with active infections (A)</p> Signup and view all the answers

What is the recommended position for a patient with Superior Vena Cava Syndrome?

<p>At a 45-90 degree angle (A)</p> Signup and view all the answers

Which of the following is a common manifestation of Spinal Cord Compression?

<p>Persistent back pain that worsens with certain movements (D)</p> Signup and view all the answers

What initial treatment is commonly administered for suspected Spinal Cord Compression?

<p>Corticosteroids (A)</p> Signup and view all the answers

Which of the following is NOT a recommended nursing assessment for a patient experiencing distress from Superior Vena Cava Syndrome?

<p>Assess for signs of improvement (D)</p> Signup and view all the answers

What is a potential cause of autonomic dysfunction in Spinal Cord Compression?

<p>Compression of the spinal cord (C)</p> Signup and view all the answers

Which diagnostic tool is considered the gold standard for diagnosing Spinal Cord Compression?

<p>MRI (C)</p> Signup and view all the answers

Which statement correctly describes a patient activity to be avoided in cases of Superior Vena Cava Syndrome?

<p>Straining (C)</p> Signup and view all the answers

What is a crucial monitoring component after a diagnosis of Spinal Cord Compression?

<p>Regular lab work for possible tumor lysis (D)</p> Signup and view all the answers

What is a serious risk associated with thrombocytopenia when platelet levels fall below 50,000?

<p>Serious bleeding (D)</p> Signup and view all the answers

Which of the following is NOT a common symptom of hypercalcemia?

<p>Heavy bleeding (A)</p> Signup and view all the answers

What initial treatment should be administered for mild or no symptoms of hypercalcemia?

<p>3-4 liters of hydration (B)</p> Signup and view all the answers

What is a primary assessment finding in cases of tumor lysis syndrome?

<p>Hyperkalemia (C)</p> Signup and view all the answers

Which of the following indicates a severe case that may require hemodialysis during hypercalcemia treatment?

<p>Severe renal failure (A)</p> Signup and view all the answers

What is an important nursing care consideration for patients with hypercalcemia?

<p>Monitor daily weight (D)</p> Signup and view all the answers

Which treatment is controversial when managing hypocalcemia in tumor lysis syndrome?

<p>IV calcium gluconate (C)</p> Signup and view all the answers

What is the main symptom of anemia due to long-term chemotherapy and suppression of RBCs?

<p>Fatigue (A)</p> Signup and view all the answers

What type of diet may be required for patients with gastrointestinal concerns in thrombocytopenia?

<p>Soft diet (A)</p> Signup and view all the answers

What is NOT a recommended action for patients with thrombocytopenia to prevent bleeding?

<p>Floss regularly (B)</p> Signup and view all the answers

What are the common metabolic disturbances associated with tumor lysis syndrome?

<p>Hyperkalemia and hypocalcemia (B)</p> Signup and view all the answers

Which EKG change might be observed in a patient experiencing hypercalcemia?

<p>QT interval shortening (A), Prolonged PR interval (B)</p> Signup and view all the answers

During hypercalcemia treatment, what is an effective approach to promote effective kidney excretion of calcium?

<p>Loop diuretics after adequate rehydration (A)</p> Signup and view all the answers

Flashcards

Neutropenia

A condition where the number of neutrophils (a type of white blood cell) is abnormally low, increasing the risk of infection.

Absolute Neutrophil Count (ANC)

A measure of the number of neutrophils in the blood, used to assess infection risk.

Oncologic Emergency

Serious complications that arise due to cancer or its treatment, often needing immediate medical attention.

Thrombocytopenia

A low platelet count, leading to increased risk of bleeding.

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Infection Risk (Neutropenia)

The chance of getting an infection increases significantly when the neutrophil count is severely low.

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Myelosuppression

A side effect of chemotherapy which temporarily reduces the body's ability to produce blood cells.

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Fever (oncology)

A potentially serious sign of infection, especially for patients with low neutrophil counts.

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Patient Teaching (Neutropenia)

Important instructions to minimize infection risk, focusing on hand hygiene and avoiding exposure to illness.

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Tumor Lysis Syndrome (TLS) Assessment

Regular monitoring of vital signs, input/output, urine analysis, electrolytes (BUN, creatinine, uric acid), and muscle function.

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SIADH Symptoms

Water retention causing hyponatremia, possibly leading to personality changes, decreased reflexes, muscle weakness, seizures, and coma.

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SIADH Treatment

Correcting sodium-water imbalance slowly, fluid restriction, and IV 3% NS in severe cases.

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TLS Monitoring

Frequent electrolyte checks (serum electrolytes, BUN/Creatinine, uric acid) are needed until levels normalize and the patient stabilizes.

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Superior Vena Cava Syndrome (SVCS)

Blood flow blockage to the heart from the upper body, leading to swelling and potential complications.

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Bleeding Precautions

Measures to prevent bleeding, including reducing risk of injury and maintaining skin integrity.

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Hypercalcemia

High calcium levels in blood, often due to bone cancer.

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Hypercalcemia Symptoms

Symptoms include increased temperature, nausea/vomiting, polyuria (excess urination), bone pain, confusion, and EKG changes.

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Hypercalcemia Treatment

Treatment involves hydration (oral or IV), possibly diuretics to flush out calcium, and medications to inhibit bone break-down.

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Tumor Lysis Syndrome

A metabolic disturbance caused by cancer cell death, releasing substances into the blood, leading to electrolyte imbalances.

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Tumor Lysis Syndrome Symptoms

Symptoms include diarrhea, lethargy, muscle cramps, nausea, vomiting, and potentially metabolic acidosis.

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Tumor Lysis Syndrome Treatment (Hydration)

Hydration is key to managing electrolyte disturbances.

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Tumor Lysis Syndrome Treatment (Hyperkalemia)

Treats high potassium through methods like avoiding potassium-containing fluids, using diuretics, and glucose/insulin infusions.

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Tumor Lysis Syndrome Treatment (Hyperuricemia)

Involves using allopurinol (inhibits uric acid) and potentially urinary/serum alkalinization.

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Anemia

Low red blood cell count, often from chemotherapy/radiation.

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Anemia Symptoms

Fatigue is the main symptom, but other factors play a role.

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Normal Calcium Level

9-11 mg/dL; Symptoms arise when levels exceed 12 mg/dL.

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Bleeding risk in thrombocytopenia

Serious risk when platelet count is below 50,000.

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Causes of SVCS

Can be extrinsic masses, masses invading the vessel wall, thrombus related to a central venous catheter, or a thrombus within the vessel.

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SVCS symptoms

Symptoms include facial and arm swelling, edema in the upper body, head/neck/chest vein swelling, headaches, visual changes, seizures, dyspnea, cyanosis, and possibly stridor. Blood pressure differences between limbs can occur.

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SVCS Treatment Strategies

Treatments for SVCS include radiation, chemotherapy, anticoagulants, surgery to remove the mass, and stenting of the SVC. Diuretics and steroids are used to manage swelling. Other treatments are used for concurrent symptoms such as dyspnea.

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SVCS treatment considerations

Diuretics should be used with caution in SVCS as it could further decrease venous return. Heparin use is important if the SVCS involves thrombus, to counter blood clots.

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Superior Vena Cava Syndrome

A condition where the superior vena cava (SVC), a major vein that carries blood from the head, neck, and arms to the heart, is blocked, usually due to a tumor or blood clot. This blockage prevents blood from flowing back to the heart, causing swelling in the face, neck, and arms.

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Superior Vena Cava Syndrome Symptoms

Common symptoms include swelling in the face, neck, and arms; shortness of breath; headache; dizziness; and coughing. As the pressure in the SVC increases, blood flow to the brain can be affected, leading to neurological symptoms like confusion and altered mental status.

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Spinal Cord Compression

A serious condition where a tumor or other mass presses on the spinal cord, causing damage to the nerves and potentially leading to paralysis or loss of sensation.

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Spinal Cord Compression Symptoms

Common symptoms include back pain that worsens when lying down or bearing weight, numbness, weakness, and difficulty with bowel or bladder control. As the condition progresses, these symptoms may become more severe and even permanent.

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Spinal Cord Compression Diagnosis

The diagnosis is made using imaging studies such as X-rays, MRI, or CT scans. MRI is considered the gold standard for visualizing the spinal cord and surrounding tissues.

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Spinal Cord Compression Treatment

Treatment aims to reduce pressure on the spinal cord, usually with corticosteroids to decrease swelling and radiation therapy to shrink the tumor. Surgery is sometimes necessary to remove the mass or decompress the spinal cord.

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Spinal Cord Compression Neurologic Monitoring

Regular neurologic checks, including assessments of strength, sensation, and reflexes, are essential to monitor the progression of the condition and determine the effectiveness of treatment.

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Spinal Cord Compression: Tumor Lysis

A complication that can occur during treatment, especially with chemotherapy, where tumor cells break down quickly, releasing large amounts of potassium and other substances into the bloodstream, potentially causing problems with the kidneys and heart.

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Study Notes

Oncology Emergencies

  • Myelosuppression encompasses various conditions affecting the bone marrow's ability to produce blood cells
  • Neutropenia—low neutrophil count, increases infection risk. An ANC (Absolute Neutrophil Count) is used to assess the risk. Levels of 1500-1000 are considered low risk, 1000-500 moderate, and 500-0 high risk. Chemotherapy is frequently the cause.
  • Thrombocytopenia—low platelet count. Normal count is 150,000-400,000. Platelet counts below 20,000 often necessitate transfusion.
  • Anemia—reduced red blood cell count. Fatigue is a frequent symptom. Epoetin (Epogen, Procrit) may be utilized, in addition to rare red blood cell transfusions.
  • Hypercalcemia—elevated blood calcium levels, common in metastatic bone diseases or multiple myeloma. Symptoms often arise when calcium levels exceed 12 mg/dL.
  • Tumor Lysis Syndrome (TLS)—a metabolic complication resulting from rapid cancer cell death during treatment. This can lead to numerous complications including hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia.
  • SIADH (Syndrome of Inappropriate Antidiuretic Hormone)—overproduction of ADH which leads to water retention and hyponatremia (low sodium).
  • Superior Vena Cava Syndrome (SVCS)—obstruction of blood flow in the superior vena cava, often caused by tumors. Characterized by swelling of the face, neck, and upper body.
  • Spinal Cord Compression—occurs when tumors compress the spinal cord or nerves. Extreme back pain and neurological symptoms are possible.

Neutropenia

  • Neutrophils make up 50-60% of white blood cells (WBCs).
  • Segmented neutrophils are mature WBCs; bands are immature neutrophils.
  • Calculating ANC: [(segmented neutrophils + bands) / 100] x WBC count.
  • Nursing Care for Neutropenia: Anticipate potential infections (pancultures), maintain hydration, administer antipyretics and antibiotics as needed, utilize colony-stimulating factors.
  • Prevention is key, especially handwashing

Thrombocytopenia

  • Low circulating platelets (normal 150,000-400,000).
  • Nursing Care: anticipate bleeding issues (e.g., petechiae, bruising); platelet counts, PT, and PTT tests are required to monitor the patient. Platelet transfusions might be necessary for extremely low counts.

Hypercalcemia

  • Assessment Findings: increased temperature, nausea and vomiting, polyuria, bone pain. constipation, hyporeflexia, seizures; can also present with decreased blood pressure and pulse, extreme thirst, anorexia, confusion, and EKG changes (often sinus bradycardia, prolonged PR, and shortened QT intervals). Renal failure is a potential serious complication.
  • Treatment: Hydration, loop diuretics; potentially administering medications to inhibit bone breakdown or increase bone formation (e.g., calcitonin or biophosphonates such as pamidronate).
  • Nursing Care: Daily labs (CMP/BMP and ionized calcium). Seizure precautions, neuro checks, vital signs monitored, daily weights, patient teaching regarding hydration, movement, and pulse monitoring.

Anemia

  • Frequent symptom of long-term chemotherapy/radiation. Often caused by products of cell destruction, inflammatory response, medications, or malnutrition.
  • RBC counts and growth factors (e.g., epoetin) are utilized for treatment.

Tumor Lysis Syndrome (TLS)

  • Serious metabolic complication arising from cancer cell death.
  • Symptoms include hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia.
  • Treatment: ongoing hydration; stop IVs containing potassium, IV hypertonic glucose and insulin, IV calcium gluconate, or possibly kaexylate. Dialysis may be needed in extreme cases.
  • Other treatment options exist for hyperuricemia (allopurinol) and hyperphosphatemia (phosphate-binding antacids).
  • Nursing Care: frequent vital signs monitoring; input and output, weight checks, strict I&O monitoring; monitoring of serum electrolytes, BUN, Creatinine, and uric acid every 6-12 hours; also observation for symptoms of electrolyte imbalances.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  • Cancer cells or chemotherapy can cause excessive ADH leading Water retention and hyponatremia.
  • Symptoms: weight gain without edema, personality changes, disorientation, decreased reflexes, generalized muscle weakness, seizures, and coma.
  • Treatments: Fluid restriction, IV 3% saline in severe cases. Careful monitoring of sodium levels is crucial

Superior Vena Cava Syndrome (SVC)

  • Blockage of the superior vena cava (vein returning blood to the heart). Symptoms often include swelling in the face and upper body, along with edema, dyspnea, and altered blood pressure between arms and legs
  • Causes usually include tumors, masses, thrombi, or clots.
  • Treatment: radiation therapy, chemotherapy to shrink tumors, possible stenting of the SVC. Anticoagulants as needed

Spinal Cord Compression

  • Tumor pressing on the spinal cord, causing pain, weakness, and loss of sensation.
  • Manifestations: intense back pain that is worse while lying down, exacerbated by coughing, sneezing, or straining, as well as motor weakness. sensory paresthesia (e.g., numbness, coldness), and loss of bowel/bladder function.
  • Diagnosis: X-rays or MRI scan.
  • Treatment: corticosteroids to reduce swelling, radiation therapy, and surgical intervention as needed.

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Oncology Emergencies NUR486 PDF

Description

Test your knowledge on various oncology emergencies such as myelosuppression, neutropenia, and tumor lysis syndrome. This quiz covers definitions, symptoms, and clinical implications related to low blood cell counts and other critical conditions in oncology. Enhance your understanding of these urgent medical situations in cancer care.

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